Thoracic Spine & Breathing

Thoracic Spine & Breathing

Movement Analysis, Sub-classification & Neuromuscular Retraining for the Thorax & Breathing Retraining

Course Summary:
This course reviews several key dynamic stability and muscle balance concepts.  The anatomy and functional classification of thoracic musculature is outlined with local and global stability muscles identified.  The thoracic spine is assessed for movement dysfunction (i.e. relative flexibility and vertical loading) and the ability of the local muscles to control segmental translation.  Rehabilitation strategies specific to the individual’s presentation are covered and logical progressions of exercises discussed. Normal respiratory function is identified and assessed in relation to movement dysfunction and dynamic stability.  The movement and stability role of the diaphragm is integrated with the local lumbar cylinder.  Based upon this systematic and logical assessment an integrated treatment approach is presented.  The effect of cervical and scapular dysfunction on thoracic stability and respiratory function are also covered.  Rehabilitation is guided by principles of rehabilitation that include problem solving strategies and options for difficult patients.  This course is orientated to a ‘hands on’ practical application of dysfunction assessment.  The relationship of articular restrictions and neurodynamic reactivity to respiratory function and stability of the thoracic spine are also discussed.

Course prerequisite: Clinical Reasoning

Suggested Pre Course Preparation: Clinical Reasoning revision and revision of spinal and shoulder girdle anatomy / musculature

Course Objectives:

After the course the participant will be able to: 

  • Identify normal breathing and assess the diaphragm with the respiratory system
  • Assess the thoracic spine to make a diagnosis of movement dysfunction
  • Understand the inter-relationship between scapular, cervical, and thoracic stability with respiratory function
  • Problem solve to prescribe appropriate exercises that relate to controlling the direction of strain and to regain muscle balance
  • Identify suitable starting points and appropriate progressions of stability exercises
  • Integrate the treatment of stability training with other techniques into clinical practice


Do you know what normal breathing is?  Do you know how to retrain it? The diaphragm is a muscle and changes with posture and pain and can affect all aspects of our function.  Breathing is an essential part of rehabilitation and needs to be addressed.

Over Breathing Syndrome
This is a common disorder, especially in chronic pain.  When you breathe off too much carbon dioxide it can cause a change in blood ph. You can experience a cascade of metabolic and chemical imbalances in the entire body.  We will teach you how to assess for this and retrain breathing.

Cervical Spine Culprit
We`ll show you how the cervical spine causes upper thoracic problems.

Inferior Anterior Glenoid (IAG)
The IAG is the position the scapula orientates following pain.  The scapular muscles help stabilize the thoracic spine.  We’ll show you how to correct it!  We have some strategies for lower trapezius and serratus anterior that you may not have seen before.

Upper Trapezius is a Good Guy Muscle
Upper trapezius does not elevate the scapula – it has a local and global stability role for the neck and shoulder girdle. It has a major stability influence on the neck, shoulder and thoracic spine. It has an anticipatory timing pattern and is delayed with pain – similar to Transversus. It also experiences sudden atrophy – similar to Multifidus. It rarely loses extensibility so assessment and retaining needs to be specific. Lower trapezius does not pull the inferior angle of the scapula down and in. There are better ways to train lower trapezius for scapular stability!

Thoracic Multifidus
We`ll give you facilitation strategies for thoracic multifidus that are different from the lumbar spine.

Myofascial Trigger Point Release (MTPR)
Mobilizer muscles tend to get short and/or dominate movements which contribute to faulty patterns and pain.  MTPR to the mobilizer muscles can create a good window of opportunity to change movement quality and help manage symptoms. 

There are some great taping techniques for the shoulder girdle and thoracic spine!

Other Rehab Options
Some people do well by going to the gym or doing things like pilates, or going to the gym, but some don’t.  We’ll show you how to give people accurate advice and what they can and can’t do.

What about the people who don’t get it?
Some people cannot or have significant difficulty learning specific exercises.  We’ll help you screen them and give you alternative rehab options.


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